Provider Demographics
NPI:1295234524
Name:PANDOLFO, MICHELLE MCLANE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MCLANE
Last Name:PANDOLFO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 10TH STREET LN NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1777
Mailing Address - Country:US
Mailing Address - Phone:828-578-6409
Mailing Address - Fax:
Practice Address - Street 1:2045 10TH STREET LN NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-1777
Practice Address - Country:US
Practice Address - Phone:828-578-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0198071041C0700X
NCC0079781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical